Reference — Maternal-Newborn
Postpartum Warning Signs
Early recognition of postpartum complications can prevent maternal morbidity and mortality. This reference covers the five major postpartum warning sign categories — hemorrhage, infection, hypertension, depression, and thromboembolism — with assessment findings, thresholds, and escalation actions.
Educational use only. Postpartum complications require immediate provider assessment and individualized management. Always follow institutional protocols and current ACOG/AWHONN guidelines. This reference is intended for nursing education and NCLEX preparation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Postpartum Hemorrhage (PPH)
| Warning Sign | Clinical Significance | Escalation Action |
|---|---|---|
| Saturation of >1 pad/hour | Excessive blood loss — threshold for PPH workup | Assess fundus, bladder; notify provider immediately |
| Clots > golf ball size | Indicates significant hemorrhage or retained tissue | Notify provider; save clots for measurement if possible |
| Boggy, unresponsive uterus | Uterine atony — #1 cause of PPH | Massage until firm; IV oxytocin; notify provider |
| Tachycardia, hypotension, pallor | Hemodynamic instability — hypovolemic shock | Emergency response; IV fluid bolus; type and crossmatch; call provider STAT |
| Perineal hematoma (expanding) | Hidden blood loss; increasing perineal pain/pressure | Do not apply pressure; notify provider; may require surgical drainage |
4 Ts of PPH Causes:
Postpartum Infection
| Warning Sign | Type | Escalation Action |
|---|---|---|
| Fever >38°C on 2 occasions after 24 hrs | Endometritis (uterine infection) | Notify provider; obtain cultures; anticipate IV antibiotics |
| Uterine tenderness on palpation | Endometritis | Report to provider; do not massage boggy uterus if tenderness suggests infection |
| Foul-smelling lochia | Uterine/cervical infection or retained tissue | Document description; notify provider |
| Wound redness, warmth, purulent drainage | Wound infection (perineal/cesarean) | Notify provider; wound culture; wound care per order |
| Unilateral breast wedge-shaped redness + fever | Mastitis | Continue breastfeeding; provider notification; antibiotics (dicloxacillin or cephalexin) |
Postpartum Hypertension
| Warning Sign | Significance | Escalation Action |
|---|---|---|
| BP ≥140/90 postpartum | Postpartum preeclampsia | Notify provider; seizure precautions; repeat BP in 4–6 hours; antihypertensives per order |
| BP ≥160/110 (severe) | Severe-range hypertension — requires treatment within 30–60 min | Notify provider STAT; antihypertensives (labetalol, hydralazine, nifedipine); magnesium may be ordered |
| Severe headache, visual changes | Severe features of preeclampsia | Immediate provider notification; neurologic assessment; seizure precautions |
| RUQ/epigastric pain, nausea | HELLP syndrome risk (hemolysis, elevated liver enzymes, low platelets) | STAT labs (LFTs, platelet count, LDH, CBC); notify provider immediately |
| New-onset seizure postpartum | Eclampsia — emergency | Call for help; protect airway; oxygen; IV magnesium sulfate; continuous monitoring |
Postpartum preeclampsia can occur up to 6 weeks postpartum; most commonly within 48–72 hours of delivery.
Postpartum Depression / Mood Disorders
| Condition | Key Features | Escalation Action |
|---|---|---|
| Postpartum blues | Days 2–3, resolves by 2 weeks; tearfulness, mood lability — normal | Reassurance; monitor for progression; adequate sleep and support |
| Postpartum depression (PPD) | Persistent >2 weeks; sadness, anhedonia, difficulty bonding, sleep disturbances | Screen with EPDS; mental health referral; therapy ± antidepressants |
| Intrusive/harmful thoughts | Thoughts of harming self or infant — always take seriously | Immediate psychiatric evaluation; safety assessment; do not leave alone with infant if risk present |
| Postpartum psychosis | Within 2 weeks; hallucinations, delusions, confusion, disorganized behavior — psychiatric emergency | Emergency psychiatric evaluation; hospitalization; antipsychotics; ensure infant safety |
Thromboembolism (DVT/PE)
| Warning Sign | Type | Escalation Action |
|---|---|---|
| Unilateral leg pain, warmth, edema, redness | Deep vein thrombosis (DVT) | Notify provider; Doppler ultrasound; anticoagulation per order; ambulation limitation |
| Sudden chest pain, dyspnea, tachycardia | Pulmonary embolism (PE) — life-threatening | Emergency response; O2; IV access; notify provider STAT; CT pulmonary angiogram |
| Hemoptysis, pleuritic chest pain | PE | Emergency response as above |
| Hypoxia, decreased O2 saturation | PE — impaired gas exchange | Supplemental oxygen; call rapid response if deteriorating |
Prevention priorities:
- Early ambulation (most effective single intervention)
- Sequential compression devices (SCDs) while in bed
- Adequate hydration
- Pharmacologic prophylaxis for high-risk patients (LMWH per order)
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American College of Obstetricians and Gynecologists (ACOG) · AWHONN · American Academy of Pediatrics (AAP) — newborn. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →